Assisted laparoscopic transhiatal esophagectomy for the treatment of esophageal cancer.

BACKGROUND: Esophageal resection for the treatment of esophageal cancer is usually associated with high morbido-mortality risks, that can be reduced using laparoscopy. Laparoscopic transhiatal esophagectomy (LTE) has the potential to improve these results but, to-date, only a few limited series of cases have been reported. This report summarizes our experience in 24 cases. OBJECTIVE: To assess the outcomes following LTE. METHODS AND MATERIALS: Between 1998 and 2005, LTE was performed in 24 patients; 18 men and 6 women with an overall mean age of 63 years (range: 36-85). Indication for surgery was lower third esophageal cancer; 11 squamous cell carcinoma and 13 adenocarcinoma. Neoadjuvant chemotherapy and radiotherapy were used in 18 patients (75%). A laparoscopic transhiatal approach was used to perform an esophagectomy with curative intent. A cervical esophagogastric anastomosis was created. RESULTS: No reversion to conventional open surgery was required. Mean anesthesia time was 293.8 min (range: 255-360). Major complications occurred in 7 patients (29.2%). Two patients (8.3%) had leakage from the cervical anastomosis. Surgical mortality was 8.3%. The median stay in Intensive Care Unit was 5 days (range: 1-29). Median hospital stay was 11.5 days (range: 7-54). At a mean follow-up of 24.9 months, 8 patients (36.4%) had disease recurrence (36.4%), global survival rate was 62.5%, and diseasefree survival rate was 50%. CONCLUSIONS: Assisted laparoscopic transhiatal esophagectomy for lower third esophageal cancer is a potentially safe and effective method when performed by surgeons with expertise in the field. Benefits from this approach need to be confirmed by further randomized studies.

Transanal evisceration caused by rectal laceration.

Transrectal evisceration caused by colorectal injury is an unusual entity. This pathology is more frequent in elderly patients and it is usually produced spontaneously. Rectal prolapse is the principal predisposing factor. An 81-year-old woman was taken to the hospital presenting exit of intestinal loops through the anus. After first reanimation measures, an urgent surgery was indicated. We observed the absence of almost every small intestine loop in the abdominal cavity; these had been moved to the pelvis. After doing the reduction, a 3 to 4 cm linear craniocaudal perforation in upper rectum was objectified, and Hartmann's procedure was performed. We investigated and knew that she frequently manipulate herself to extract her faeces. The fast preoperative management avoided a fatal conclusion or an extensive intestinal resection. Reasons that make us consider rectal self-injury as the etiologic factor are explained.

[Mucocele of the appendix: Presentation of 31 cases]. / Mucocele apendicular: presentación de 31 casos.

UNLABELLED: Mucocele of the appendix is a very uncommon disease estimated to be seen in 0.2-0.3% of all appendectomies (0.28% in our series). The term "mucocele" means dilation of the appendix due to mucus, caused either by a benign process or a malignant one (cystadenoma or adenocarcinoma). MATERIAL AND METHODS: We present a series of 31 cases (17 females) treated over 18 years and with a mean age of 62 years. The most frequent clinical symptom (14 cases, 45%) was pain in the right iliac fossa of less than 72 h onset which simulates acute appendicitis. RESULTS: The histology results showed that it was benign in 21 cases. The appendix was removed in all cases; five by laparoscopy, with caecal resection in 8 cases (1 was a cystadenocarcinoma) and right ileocolectomy in 15 patients (9 malignant). CONCLUSION: Follow up is recommended, not only to monitor the appendicular disease, but also due to the high incidence of synchronic or metachronic tumour processes in other areas.

Effects of dopamine in isolated rat colon strips.

The aim of the present work is to investigate the effects of dopamine on isolated rat colon strips, and whether dopamine receptors are involved in these effects. Experiments on spontaneous motility and under potassium contraction were performed with dopamine and isoprenaline, both in the absence and presence of antagonists (distal colon strips, isotonic recording, Tyrode solution, 31 degrees C, 1 g of resting tension). At higher concentration (10(-4) mol/L), dopamine abolished spontaneous motility of the rat colon and this effect was not modified by antagonists. In isolated rat colon strips that were depolarized with potassium, dopamine produced concentration-dependent relaxation, without significant differences in reserpinized rats. Preincubation with sulpiride or Sch 23390, dopamine antagonists, did not modify the effects of dopamine. Propranolol shifted the concentration-response curve to the right, though in a noncompetitive manner. Prazosin and yohimbine (alpha-antagonists) did not modify the response to dopamine. Isoprenaline produced a concentration-dependent relaxant response to the KCl-induced contraction antagonized by propranolol, but not by prazosin, in a noncompetitive manner. In conclusion, dopamine exhibits a relaxant effect on the isolated rat colon, which is not mediated by specific dopamine receptors or alpha-adrenoceptors but it may be mediated by atypical beta-adrenoceptors.

Mujer joven con masa quística intraabdominal gigante / Young woman with a giant intraabdominal cystic mass

Introducción. Las masas quísticas intraabdominales gigantes son, en nuestro medio, una entidad poco frecuente. Los orígenes más frecuentes de las mismas son el ovario, el mesenterio y el omento. Caso clínico. Mujer de 29 años, con clínica de aumento del perímetro abdominal y dolor en hipogastrio-pelvis de meses de evolución. Mediante pruebas de imagen se evidencia una tumoración quística intraabdominal gigante de 35 × 31 × 14 cm que desplaza estructuras viscerales y ocupa prácticamente toda la cavidad abdominal, sin aparente origen ovárico. Tras laparotomía y ooforosalpingectomía derecha se confirma un cistadenoma seroso de 14 kg. Conclusiones. La presencia de una lesión quística intraabdominal debe plantear un diagnóstico diferencial entre diversos orígenes (ovario, mesenterio, genitourinario, etc.). Incluso hoy en día con los avances en imagen se llega al diagnóstico definitivo en quirófano. En los cistadenomas serosos, la exéresis del quiste junto con el anexo afectado es el tratamiento de elección (AU)

Introduction. Giant intra-abdominal cystic masses are a rare entity in our environment. The most common locations are the ovary, mesentery, and omentum. Case report. A 29-year-old woman gave a history of abdominal distension and pain in the lower abdomen-pelvis for several months. Radiological studies showed a giant cystic tumor measuring 35 × 31 × 14 cm, displacing visceral structures and occupying almost the entire abdominal cavity, with no apparent ovarian origin. After laparotomy and right oophorosalpingectomy, the existence of a 14-kg serous cystadenoma was confirmed. Conclusions. The presence of an intraabdominal cystic lesion requires a differential diagnosis among various origins (ovary, mesentery, urinary bladder, etc.). Even today, with advances in radiology, the definitive diagnosis is reached during surgery. In serous cystadenomas, the treatment of choice is excision of the cyst and affected annex(AU)

Tratamiento del vólvulo gástrico agudo mediante abordaje laparoscópico / Laparoscopic treatment of acute gastric volvulus

Introducción El vólvulo gástrico es una entidad clínica poco frecuente y se asocia a hernias hiatales tipo ii-iii. Su presentación aguda constituye una urgencia quirúrgica. Pese a su baja frecuencia, ya se han publicado resultados sobre el tratamiento laparoscópico. Material y métodos Estudio retrospectivo de todos los casos diagnosticados de vólvulo gástrico agudo intervenidos por vía laparoscópica desde 1998 a 2010. Se describe la técnica quirúrgica, la evolución postoperatoria y el seguimiento clínico. Resultados Se identificaron 10 casos, uno era un vólvulo primario y el resto secundarios. A 7 pacientes se les realizó una gastropexia anterior como único procedimiento. En los 3 restantes se llevó a cabo fundoplicatura de Nissen y cierre de los pilares con refuerzo protésico. La evolución postoperatoria fue favorable en 9 pacientes, con inicio precoz de la dieta y alta en 48-72h. Con un seguimiento medio de 18 meses, solo hemos constatado una recidiva herniaria radiológica y ninguna recidiva del vólvulo. Conclusión La gastropexia anterior por laparoscopia es, en nuestra experiencia, un procedimiento efectivo y con baja morbilidad para el tratamiento del vólvulo gástrico agudo en pacientes con elevado riesgo quirúrgico (AU)

Introduction Gastric volvulus is an uncommon clinical condition and is associated with type ii-iii hiatal hernias. Its acute presentation constitutes a surgical emergency. Despite its low frequency, results of laparoscopic treatment have already been published. Material and methods A retrospective study was performed on all cases diagnosed with gastric volvulus undergoing laparoscopic surgery between 1998 and 2010. The surgical technique, the post-operative outcome, and the clinical follow-up are described. Results A total of 10 cases were identified, one was a primary gastric volvulus, and the remainder were secondary. A laparoscopic anterior gastropexy as the sole procedure was performed on 7 patients. A Nissen fundoplication with mesh reinforcement of the crural closure was performed on the 3 remaining cases. Postoperative outcome was uneventful in 9 patients, with an early start of the diet, and hospital discharge between 48-72h. After a mean follow-up period of 18 months, radiological hernia recurrence occurred in one case but recurrence of the volvulus was not observed. Conclusion Laparoscopic anterior gastropexy is, in our experience, an effective and safe procedure with a low morbidity, for the treatment of acute gastric volvulus in patients with high surgical risk (AU)

Tratamiento de aneurismas viscerales mediante embolización arterial selectiva y abordaje laparoscópico / Laparoscopic approach in the treatment of visceral aneurysms by selective arterial embolisation

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Mucocele apendicular: presentación de 31 casos / Mucocele of the appendix: Presentation of 31 cases

El mucocele apendicular es una enfermedad poco frecuente que se estima en el 0,2–0,3% de todas las apendicectomías y que en nuestra serie supone el 0,28%. El término mucocele hace referencia a la dilatación del apéndice por moco, causada tanto por un proceso benigno como maligno (cistoadenoma o adenocarcinoma).Material y métodos Presentamos una serie de 31 casos (17 mujeres) tratados en 18 años y con una edad media de 62 años. El dato clínico mas frecuente fue dolor en la fosa ilíaca derecha de menos de 72h de evolución que simulaba una apendicitis aguda, lo que ocurrió en 14 casos (45%).Resultados En 21 casos el estudio histológico mostró benignidad. En todos los casos se extirpó el apéndice, en 5 casos por laparoscopia, y se añadió resección cecal en 8 casos (uno era un cistoadenocarcinoma) e ileocolectomía derecha en 15 pacientes (9 eran malignos).Conclusiones Se recomienda el seguimiento, no sólo para el control de la enfermedad apendicular, sino por la alta incidencia de procesos tumorales sincrónicos o metacrónicos en otras áreas (AU)

Mucocele of the appendix is a very uncommon disease estimated to be seen in 0.2–0.3% of all appendectomies (0.28% in our series). The term “mucocele” means dilation of the appendix due to mucus, caused either by a benign process or a malignant one (cystadenoma or adenocarcinoma).Material and methods We present a series of 31 cases (17 females) treated over 18 years and with a mean age of 62 years. The most frequent clinical symptom (14 cases, 45%) was pain in the right iliac fossa of less than 72h onset which simulates acute appendicitis. Results The histology results showed that it was benign in 21 cases. The appendix was removed in all cases; five by laparoscopy, with caecal resection in 8 cases (1 was a cystadenocarcinoma) and right ileocolectomy in 15 patients (9 malignant).Conclusion Follow up is recommended, not only to monitor the appendicular disease, but also due to the high incidence of synchronic or metachronic tumour processes in other areas (AU)

Assisted laparoscopic transhiatal esophagectomy for the treatment of esophageal cancer

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Background. Esophageal resection for the treatmentof esophageal cancer is usually associatedwith high morbido-mortality risks, that can be reducedusing laparoscopy. Laparoscopic transhiatalesophagectomy (LTE) has the potential to improvethese results but, to-date, only a few limited seriesof cases have been reported. This report summarizesour experience in 24 cases.Objective. To assess the outcomes following LTE.Methods and materials. Between 1998 and 2005,LTE was performed in 24 patients; 18 men and 6women with an overall mean age of 63 years(range: 36-85). Indication for surgery was lowerthird esophageal cancer; 11 squamous cell carcinomaand 13 adenocarcinoma. Neoadjuvant chemotherapyand radiotherapy were used in 18 patients(75%). A laparoscopic transhiatal approach wasused to perform an esophagectomy with curativeintent. A cervical esophagogastric anastomosis wascreated.Results. No reversion to conventional open surgerywas required. Mean anesthesia time was 293.8 min(range: 255-360). Major complications occurred in 7patients (29.2%). Two patients (8.3%) had leakagefrom the cervical anastomosis. Surgical mortalitywas 8.3%. The median stay in Intensive Care Unitwas 5 days (range: 1-29). Median hospital stay was11.5 days (range: 7-54). At a mean follow-up of 24.9months, 8 patients (36.4%) had disease recurrence(36.4%), global survival rate was 62.5%, and diseasefreesurvival rate was 50%.Conclusions. Assisted laparoscopic transhiatal esophagectomyfor lower third esophageal cancer is apotentially safe and effective method when performedby surgeons with expertise in the field.Benefits from this approach need to be confirmedby further randomized studies