[Immune response during laparoscopic and open living donor nephrectomy. An experimental pig model]. / Respuesta inmunohumoral durante la nefrectomía abierta y laparoscópica de donante vivo. Modelo porcino experimental.

INTRODUCTION: It's been demonstrated laparoscopic access determines a lower surgical stress, by measurement of several markers as different interleuquines (IL) or C-reactive protein (CRP). Endothelin 1 (ET-1) is a powerful vasoconstrictor produced in renal endothelium scarcely studied in laparoscopy. The objective of this study is to analyze immune response during laparoscopic and open donor nephrectomy, in a porcine experimental model by means of measuring IL-2, 10, tumoral necrosis factor alpha (TNFalpha), CRP and ET-1. METHODS: Twenty pigs underwent left nephrectomy, 10 by laparoscopy and 10 by open approach in an experimental model. Both groups were monitorized IL-2, 10, TNF alpha, ET-1 at basal, immediately post surgery, first, third, fifth and seventh days after procedure. RESULTS: The comparative analysis between groups demonstrated a significant increase in levels of CRP (1.44+/-0.88 vs 1.32+/-0.14 mg/dl, p=0.046), TNF alpha (131.14+/-41.37 vs 57.19+/-23.71 pg/ml, p>0.001) and ET-1 (0.91+/-0.49 vs 0.56+/-0.5 fmol/ml, p=0.001) of open nephrectomy group, as a higher levels of IL-2 in laparoscopic group. CONCLUSIONS: Open donor nephrectomy determines a higher immune response than laparoscopic approach. The importance of this fact over the ischemia-reperfusion syndrome or the immediate function of graft is not clearly established.

Coagulative system activation and fibrinolytic system inhibition activities arise from tumoral draining vein in colon carcinoma.

UNLABELLED: Hypercoagulability and activation/inhibition of the fibrinolytic system have been observed in abdominal cancer surgery. Because surgery itself and also neoplastic diseases are associated with these situations, a method for separating the origin of these two processes was designed. Eighteen patients with colon cancer who underwent a surgical procedure were studied: Immediately before surgery blood was taken from a peripheral vein. During the surgical procedure, before the exclusion of tumoral tissue from general circulation and at the same time of a second peripheral vein blood sample, a blood sample was taken from the main tumoral draining vein. Platelet-poor plasma samples were aliquoted and stored at -72 degrees C, ready for analytical procedures. RESULTS: A moderate activation of the fibrinolytic system during surgery was observed, expressed by elevation of tissue plasminogen activator (t-PA) (P<.05) and D-dimer (DD) (P<.05) levels, without changes in fibrinogen (FG), plasminogen (PG) or antiplasmin (AP) levels. There were no modifications in antithrombin III (AT-III) and protein C (PC) levels. In the tumoral draining vein samples, there was a high elevation of levels of thrombin-antithrombin III complexes (TAT) (P<.001) and PAI-1 (P<.01), compared with the second sample peripheral vein. There was no difference between peripheral and tumoral vein sample levels of AT-III, PC, FG, DD, PG and AP. CONCLUSIONS: The tumour itself is the origin of hypercoagulability (TAT) and fibrinolytic system inhibition (PAI-1); the surgical procedure elicits an evident though moderate activation of the fibrinolytic system (t-PA and DD elevation).

Endoanal ultrasound in perirectal abscesses.

INTRODUCTION: Transrectal ultrasound is a useful exploration in the assessment of local spread of rectal tumors. AIM: The aim of this study has been the knowledge of the results of transrectal ultrasound in perirectal abscesses. PATIENTS AND METHODS: Forty patients suffering from perianal septic disease were examined with endoanal echography before surgical approach. The endorectal probe used was initially of 5 MHz and in the last 25 patients of 7.5 MHz. RESULTS: The examination could not be done in 8 patients because severe pain originated by the introduction of the probe in the anal canal. The echographic findings show the exact location and extension of the abscesses as confirmed by the surgical exploration. In three patients we suspected a perirectal abscess due to fever and anal pain but the anal exploration was normal; the ultrasonography showed the collection in all patients and two of them were treated by echoguided drainage. CONCLUSIONS: Transrectal ultrasonography localizes and defines the extension of perirectal abscesses. It is a very important diagnostic and therapeutic tool in patients with clinical presumption, but not confirmation, of what kind of abscesses.

[Modification of the hemodynamic parameters and peripheral vascular flow in a porcine experimental of model of laparoscopic nephrectomy]. / Modificaciones de los parámetros hemodinámicos y de los distintos flujos vasculares periféricos en modelo experimental porcino de nefrectomía laparoscópica.

OBJECTIVES: It has been demonstrated that abdominal high-pressure and the use of CO2 pneumoperitoneum induce changes of the cardiovascular and respiratory systems, attributable to two factors: changes of the cardiac output (CO) and hypercarbia. Other modifications derived from these facts include changes of the systemic vascular resistances (SVR), blood pressure (BP), central venous pressure (CVP), vascular changes like modifications of the renal blood flow (RBF), carotid flow (CF), portal flow, and hepatic artery flow (HAF). Our objective is to analyze the hemodynamic modifications induced by pneumoperitoneum on renal blood flow, carotid flow, portal flow and hepatic artery flow in a porcine experimental model. METHODS: We compared two groups of pigs: CONTROL group (n = 10) and LAPAROSCOPIC group (n = 10), undergoing open or laparoscopic nephrectomy respectively. In every case, catheters were inserted into the right external jugular vein and femoral artery and cardiac output, CVP, blood pressure and systemic vascular resistances (calculated as RVS = (BP/CVP)x 80/CO); these measurements were taken at the following times: baseline, 5, 30, 60 min. and postoperatively. Renal blood flow, carotid flow, portal flow and hepatic artery flow were registered by means of an electromagnetic probe around the vessel 30 minutes after the start of surgery. RESULTS: Comparative analysis shows: an increase of cardiac output in the laparoscopic group, the difference which was maximal at 30 minutes (4.33 + 0.73 vs. 8 .54 + 1.26 l/min., p < 0.,001); a descent of the systemic vascular resistances (1118.81 + 302.52 vs. 663.37 + 81.45 dynes .s.cm5, p < 0.001) and an increase of blood pressure (66.5 + 11.52 vs. 80.25 + 2.49 mm Hg in the laparoscopic group. Flow analysis showed an increase of the carotid artery flow (125.73 + 41.69 vs. 291.7 + 51.52 ml/min., p < 0.001) and a decrease of portal flow (973.67 + 131.70 vs. 546.83 + 217.53 ml/min., p = 0.001) and hepatic artery flow (278.00 + 94.71 vs. 133.33 + 112.32 ml/min., p = 0.03) in the laparoscopic group. There were no significant differences in renal blood flow with the volume expansion used. CONCLUSIONS: Laparoscopic nephrectomy conditions an increase of carotid flow, probably secondary to the increase of cardiac output, and also a diminishment of hepatic perfusion, both arterial and portal. Nevertheless, volume expansion and the limitation of intra-abdominal pressure to 12 mm Hg enable to maintain similar renal blood flow in both groups.

Refuerzo de Anastomosis esofagogástrica con Tachosil por vía toracoscópica / Thoracoscopic esophagogastric anastomoses covered with Tachosil

El abordaje mínimamente invasivo en el tratamiento de la patología oncológica esofagogástrica aporta grandes ventajas respecto al dolor postoperatorio y las complicaciones pulmonares fundamentalmente derivadas del abordaje clásico por toracotomía. La realización de la anastomosis digestiva intratorácica por vía toracoscópica es todavía un reto técnico y grave problema postoperatorio de difícil manejo. Aportamos la descripción de un caso realizado por nuestro equipo en el que la anastomosis se reforzó con una placa de Tachosil(R), una material hemostático con probada eficacia en la disminución de tasas de fístula postoperatoria en anastomosis digestivas

The minimally invasive boarding in the treatment of oesophagus and gastric cancer contributes big advantages with regard to the postoperatory pain and the pulmonary complications fundamentally derived from the classic boarding for thoracotomy approach The accomplishment of the intrathoracic thoracoscopic digestive anastomoses is still a technical challenge and serious problem with difficult managing and control. We contribute the description of a case performed by our team in which the anastomoses reinforced with Tachosil's plate materially hemostatic with proven efficiency in the decrease of rates of postoperatory digestive leak

Mejora de la calidad de vida y pérdida de peso en pacientes obesos sometidos a gastrectomía tubular, un procedimiento seguro en cirugía bariátrica / Improvement of th quality of life and loss of weight in obese patients with sleeve gastrectomy, a safe procedure in bariatric surgery

Introducción: En relación con el Porcentaje de Exceso de Peso Perdido, la gastrectomía tubular ha demostrado ser superior a la banda gástrica ajustable, obteniendo resultados similares al bypass en el primer año. La evaluación de la calidad de vida se realiza mediante diferentes escalas, entre ellas el sistema BAROS. Evaluamos la satisfacción de los 100 primeros pacientes intervenidos en nuestro hospital con esta técnica. Material y Métodos: Se indicó la gastrectomía tubular siguiendo nuestro protocolo de tratamiento. Se realiza según técnica habitual con cinco puertos. La recogida de datos se ha basado en la revisión sistemática de las historias clínicas. La evaluación de la calidad de la cirugía se analiza con escala BAROS. El análisis de la pérdida ponderal se realiza utilizando el porcentaje de exceso de peso perdido (%EPP)[(peso inicial-peso actual/peso inicial-peso ideal)x100]. Resultados: El IMC medio de los pacientes intervenidos fue 43 kg/m2 con una desviación típica de 4,8 y mínimo y máximo de 32 kg/m2 y 63 kg/m2 respectivamente. En las revisiones posteriores, el porcentaje del exceso de peso perdido (%EPP) era del 37% a los 6 meses, con una desviación típica de 17 y una p50 del 54% y a los 18 meses en el 63% con una desviación típica de 19 y una p50 del 64%. El cuestionario BAROS fue aplicado al 98% de los pacientes de la muestra inicial. Encontramos que el 21% de los pacientes estudiados presentaron una puntuación excelente, el 43% muy buena, el 21% buena, el 10% regular

Introduction: In relation with excess weight loss, sleeve gastrectomy there has demonstrated being superior to the adjustable gastric band obtaining results similar to bypass in the first year. The evaluation of the quality of life is realized by means of different scales, including BAROS scale. We evaluate the satisfaction of the first 100 patient operated in our hospital. Methods: Sleeve gastrectomy was indicated following our protocol of treatment. It was performed under the usual surgical technique with five ports. The withdrawal of information has been based on the systematic review of clinical reports. Evaluation of quality of life was analyzed by BAROS scale. Analysis of weight loss was realized using the percentage of excess weight loss (%EWL) Results: The average BMI was 43kg/m2 with standard deviation of 4.8 and minimum and maximum of 32kg/m2 and 63 kg/m2 respectively. In posterior reviews, %EWL was 37% on 6 moths, with standard deviation of 17 and p50 54% and on 18 months in 63% with standard deviation of 19 and p50 64%. The BAROS scale was applied to 98% of the patients. 21% of studied patients presented an excellent, 43% very good, 21% good and 10% regulate

Respuesta inmunohumoral durante la nefrectomía abierta y laparoscópica de donante vivo. Modelo porcino experimental / Immune response during laparoscopic and open living donor nephrectomy. An experimental pig model

Introducción: Se ha demostrado la menor agresividad quirúrgica provocada por el abordaje laparoscópico, en base a la medición de diversos marcadores de estrés postquirúrgico, entre los que se encuentran distintas interleuquinas (IL) y la proteína C reactiva (PCR). La endotelina 1 (ET-1) es un vasoconstrictor potente producido en el endotelio renal escasamente analizado en el curso de la cirugía laparoscópica. El objetivo del trabajo es analizar comparativamente la respuesta inmunohumoral inducida por las nefrectomías laparoscópica y abierta en un modelo experimental porcino, en base a la cuantificación de la PCR, las IL-2, 10, el factor de necrosis tumoral alfa (TNF alfa), y la ET-1.Material y métodos: Se analizan comparativamente dos grupos de cerdos de 25-40 Kg, un grupo CONTROL (N=10) y grupo LAPAROSCÓPICO (N=10), a los que se les realiza una nefrectomía abierta o laparoscópica respectivamente. Se determinó en sangre venosa periférica los niveles de PCR, IL-2, IL-10, TNF α y ET-1. Las determinaciones analíticas se realizaron en los momentos: basal, postcirugía, 1, 3, 5, y 7 días postquirúrgico. Resultados: El análisis comparativo de ambos grupos demuestra un aumento estadísticamente significativo de la PCR(1,44+ 0,88 vs 1,32 + 0,14 mg/dl, p=0,046), TNF α (131,14 + 41,37 vs 57,19 + 23,71 pg/ml, p>0,001) y ET-1 (0,91 + 0,49vs 0,56 + 0,5 fmol/ml, p=0,001) del grupo abierto en comparación con el grupo control, así como una elevación de la IL-2 en el grupo laparoscópico. Conclusiones: La respuesta inmunohumoral inducida por la nefrectomía abierta es superior a la de la nefrectomía laparoscópica en el curso de la donación. La importancia de este hecho en el síndrome isquemia reperfusión o la función inmediata del injerto no está claramente establecida (AU)

Introduction: It’s been demonstrated laparoscopic access determines a lower surgical stress, by measurement of several markers as different interleuquines (IL) or C- reactive protein (CRP). Endothelin 1 (ET-1) is a powerful vasoconstrictor produced in renal endothelium scarcely studied in laparoscopy. The objective of this study is to analyze immune response during laparoscopic and open donor nephrectomy, in a porcine experimental model by means of measuring IL-2,10, tumoral necrosis factor α (TNFα), CRP and ET-1.Methods: Twenty pigs underwent left nephrectomy, 10 by laparoscopy and 10 by open approach in an experimental model. Both groups were monitorized IL-2, 10, TNF α, ET-1 at basal, immediately post surgery, first, third, fifth and seventh days after procedure. Results: The comparative analysis between groups demonstrated a significant increase in levels of CRP (1,44 + 0,88vs 1,32 + 0,14 mg/dl, p=0,046), TNF α (131,14 + 41,37 vs 57,19 + 23,71 pg/ml, p>0,001) and ET-1 (0,91 + 0,49 vs 0,56+ 0,5 fmol/ml, p=0,001) of open nephrectomy group, as a higher levels of IL-2 in laparoscopic group. Conclusions: Open donor nephrectomy determines a higher immune response than laparoscopic approach. The importance of this fact over the ischemia-reperfusion syndrome or the immediate function of graft is not clearly established (AU)

Modificaciones de los parámetros hemodinámicos y de los distintos flujos vasculares periféricos en modelo experimental porcino de nefrectomía laparoscópica / Modification of the hemodynamic parameters and peripheral vascular flow in a porcine experimental of model of laparoscopic nephrectomy

Objetivo: Se ha demostrado que la hiperpresión abdominal y la utilización del neumoperitoneo con CO2, provocan cambios en los aparatos cardiovascular y respiratorio, atribuibles a dos factores: alteraciones en el gasto cardiaco (GC) e hipercarbia. Otras alteraciones derivadas de estos hechos son los cambios en las resistencias vasculares sistémicas (RVS), la tensión arterial (TA), la presión venosa central (PVC), cambios vasculares como las alteraciones en el flujo sanguíneo renal (FSR), flujo carotídeo (FAC), flujo portal (FP) y flujo de la arteria hepática (FAH). Nuestro objetivo es analizar las modificaciones hemodinámicas producidas por el neumoperitoneo sobre los FSR, FC, FP y FAH en modelo experimental porcino. Métodos: Se analizan comparativamente dos grupos de cerdos, un grupo CONTROL (N=10) y grupo LAPAROSCÓPICO (N=10), a los que se les realiza una nefrectomía abierta o laparoscópica respectivamente. En ambos grupos se canaliza la vena yugular externa derecha y la arteria femoral y se monitoriza el GC, la PVC, la TA, las RVS (calculada mediante la fórmula RVS=(TA-PVC)*80/GC); estas determinaciones se realizan en los momentos: basal, 5, 30, 60 minutos y postcirugía. Mediante sonda electromagnética alrededor del vaso, se registran los FSR, FC, FP y FAH a los 30 minutos de iniciada la intervención quirúrgica. Resultados: El análisis comparativo de ambos grupos demuestra un aumento del GC en el grupo laparoscópico, cuya diferencia fue máxima a los 30 minutos (4,33 + 0,73 vs 8,54 + 1,26 l/min, p< 0,001); un descenso de las RVS (1118,81 + 302,52 vs 663,37 + 81,45 dinas x s x cm-5 p< 0,001) y un aumento de la TA del grupo laparoscópico (66,5 + 11,52 vs 80,25 + 2,49 mm Hg, p= 0,004). El análisis de los flujos demostró un aumento del FAC (125,73 + 41,69 vs 291,70 + 51,52 ml/min, p<0,001) y una disminución del FP (973,67+ 131,70 vs 546,83+ 217,53 ml/min, p= 0,001) y del FAH (278,00 + 94,71 vs 133,33+112,32 ml/min, p=0,03) en el grupo laparoscópico. No existieron diferencias significativas en el FSR con la expansión de la volemia utilizada. Conclusiones: La nefrectomia laparoscópica condiciona un aumento del FC, posiblemente secundario al aumento del gasto cardiaco, así como un descenso de la perfusión hepática, tanto arterial como portal. Sin embargo, la expansión de la volemia y la reducción de la PIA a 12 mmHg permiten mantener el FSR semejante en ambos grupos (AU)

Objectives: It has been demonstrated that abdominal high-pressure and the use of C02 pneumoperitoneum induce changes of the cardiovascular and respiratory systems, attributable to two factors: changes of the cardiac output(CO) and hypercarbia. Other modifications derived from these facts include changes of the systemic vascular resistances (SVR), blood pressure (BP), central venous pressure (CVP), vascular changes like modifications of the renal blood flow (RBF), carotid flow (CF), portal flow, and hepatic artery flow (HAF). Our objective is to analyze the hemodynamic modifications induced by pneumoperitoneum on renal blood flow, carotid flow, portal flow and hepatic artery flow in a porcine experimental model. Methods: We compared two groups of pigs: CONTROL group (n = 10) and LAPAROSCOPIC group (n = 10), undergoing open or laparoscopic nephrectomy respectively. In every case, catheters were inserted into the right external jugular vein and femoral artery and cardiac output, CVP, blood pressure and systemic vascular resistances (calculated as RVS = (BP/CVP)x 80/CO); these measurements were taken at the following times: baseline, 5, 30, 60 min. and postoperatively. Renal blood flow, carotid flow, portal flow and hepatic artery flow were registered by means of an electromagnetic probe around the vessel 30 minutes after the start of surgery. Results: Comparative analysis shows: an increase of cardiac output in the laparoscopic group, the difference which was maximal at 30 minutes (4.33 + 0.73 vs. 8 .54+ 1.26 l/min., p < 0,001); a descent of the systemic vascular resistances (1118.81+ 302.52 vs. 663.37+ 81.45 dynes .s.cm5, p < 0.001) and an increase of blood pressure (66.5+ 11.52 vs. 80.25+ 2.49 mm Hg in the laparoscopic group. Flow analysis showed an increase of the carotid artery flow (125.73+ 41.69 vs. 291.7+ 51.52 ml/min., p < 0.001) and a decrease of portal flow (973.67+ 131.70 vs. 546.83+ 217.53 ml/min., p = 0.001) and hepatic artery flow (278.00+ 94.71 vs. 133.33+ 112.32 ml/min., p = 0.03) in the laparoscopic group. There were no significant differences in renal blood flow with the volume expansion used. Conclusions: Laparoscopic nephrectomy conditions an increase of carotid flow, probably secondary to the increase of cardiac output, and also a diminishment of hepatic perfusion, both arterial and portal. Nevertheless, volume expansion and the limitation of intra-abdominal pressure to 12 mm Hg enable to maintain similar renal blood flow in both groups (AU)